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PCM 4 Midterm > LE XR > Flashcards

LE XR Flashcards

1
Q

Distal femur fracture

  1. Tests
  2. Exam
  3. Managment
  4. Disposition
A
  1. AP/lateral XR; CT angiogram if diminished pulses after reduction
  2. Pain/swelling/defortmity of distal thigh; popliteal injury if severe
  3. Posterior long leg splint; dont bear weight
  4. Consult with orthopedic while in ED; almsot always need surgery
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2
Q

Femoral shaft fracture =

  1. What is it?
  2. Tests
  3. Exam
  4. Managment
  5. Disposition
A
  1. Fx at shaft of femur begins 5 cm distal to the lesser trochanter and end 6-8 cm proximal to the adductor tubercle MC due to MVC, peentrating trauma, falls
  2. AP/lateral XR; (Pelvis or knee XR to see if concurrent injury)
  3. Pain/swelling/tender thigh; short leg
  4. Traction splint, unless fracture or disclocation at pelvis, knee, ankle; dont bear weight
  5. Consult with orthopedic while in ED; almsot always need surgery
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3
Q

Hip dislocation =

  1. What is it?
  2. types
  3. Tests
  4. Exam
  5. Managment
  6. Disposition
A
  1. femoral head is displcaed from acetabulum; simple (w/o any assx fx) o complex (w fx)
  2. AP/lateral XR; CT for occult fc
  3. Exam
    1. Posterior = leg is ADDUCTED and IR (PADDIR)
    2. Anteiror = leg is ABducted and ER (AABER)
  4. Reduce within 6 hours and immobilize in knee immobilizer; protected weight-bearing
  5. Consult with orthopedic while in ED;
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4
Q

Hip Fracture =

  1. What is it?
  2. Tests
  3. Exam
  4. Managment
  5. Disposition
A
  1. Any fracture of proximal femur; within 5 cm of lesser trochanter
  2. AP of hip/pelvis; MRI for occult fx
  3. Exam
    1. Pain with ROM, short leg, ER
  4. immobilize, no weight
  5. Consult with orthopedic while in ED; almsot always need surgery
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5
Q

Fibula Fracture =

  1. What is it?
  2. Tests
  3. Exam
  4. Managment
  5. Disposition
A
  1. Fx due to direct trauma over lateral aspect of leg
  2. AP/lateral of lower leg
  3. Exam
    1. Pain worse with eversion
  4. Posterior short leg split for comfort.; weight w critches
  5. Discharge and follow up w orthopedic
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6
Q

Ottawa knee rule

A
  1. > 55 YO
  2. Isolated tenderness on patella
  3. Tenderness on fibular head
  4. Cant flex knee to 90 degress
  5. Cant bear weight immediately incident and in ED
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7
Q
  • Sensitivity is ___% for the Ottawa Ankle Rule with moderate specificity
A

100%

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8
Q

Ottawa ankle rule can be used in children ____, but exclusdes

A

children >6

NO: PG women, intoxicated patients, head injuries

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9
Q

Ottawa ankle rule

A
  1. any pain along malleolar region AND
    1. tenderness at tip of medial/lateral malleolus
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10
Q

a broad term that describes the movement of fracture fragments (distal relative to proximal)

A

displacement

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11
Q

extent of angulation relative to the long axis of the bone.

A

• Angulation/alignment

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12
Q

the amount of contact between the ends of the fracture fragments.

A

Apposition

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13
Q

used to describe when fracture fragments are line side-by-side.

A

Bayonet apposition

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14
Q
  • _______: describes when fragments are pulled apart
  • ______: describes when fragments are pushed together
A
  • Distraction: describes when fragments are pulled apart.
  • Impaction: describes when fragments are pushed together
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15
Q

what is rotation

A

extent of rotation of the distal fracture fragment relative to the proximal portion (often clinically apparent).

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16
Q

Management of Salter-Harris fractures

A
  1. Reduction
  2. Splint
  3. dont bear weight
  4. Ortho consult
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17
Q

Type ____ of Salter-Harris classification often require surgical management.

A

3-5

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18
Q
  • Involve transverse fracture through the growth plate (physis)
19
Q

- Tenderness over the physis should be a presumed SH type-___

20
Q

Fracture through physis and metaphysis

A

Type 2 = MC type

21
Q
  • Fracture through physis + epiphysis + the articular surface
22
Q

Fracture through metaphysis + physis + epiphysis involving the articular surface.

23
Q

Compression fracture of the growth plate (physis).

  • Often missed or thought to be a Salter-Harris I
  • Suspect if mechanism of injury involves a significant axial load.
  • Often diagnosed after arrest of growth has developed
24
Q

Posterior knee splint

Causes

Procedure

Postioning

A
  1. Patella fracture/ injury/dislocation
  2. Quad tendon injury
  3. ST injury to knee
  4. Pt legs are too big for knee immobilizer

Distal to glutal fold => 6cm above malleoli

Flex knee 15-20 deg

25
**_Posterior long leg splint_** **Inidications** Proecdure Postionin
1. **Knee dislocation** 2. **Tibial plateu/tibia fx** 3. **Distal femur fx** ## Footnote **Distal gluteal fold =\> base of toes** **Ankle in neutral position (90 deg to leg); knee flexed 15 - 20**
26
**Posterior short leg splint with stirrup**
1. **Fracture, disolocation, sprain** 1. calcaneus 2. talus 3. ankle 4. metasarsal 5. Midfoot 2. **Injury to achilles tendon**
27
**Short-Leg:** With patient prone, start at plantar surface of metatarsal heads (base of the toes) and end at the level of the fibular head (just below the knee) **Stirrup:** Place after short leg, start 3 to 4 cm below the level of the fibular head, extend under the plantar surface of the foot, and at the starting height on contralateral side of leg
28
**_Collateral Ligament Injury_** 1. XR 2. How do you get injury to MCL and LCL
1. **AP/lateral** 2. **MCL** = _valgus_ + _ER stress_ to a _flexed knee_ 3. **LCL** = _varus_ stress +/- IR
29
MAnagement a **MCL/LCL injury** Disposition
1. **Knee immobilizer** if signif ligament laxity 2. Discharge from ED and F/U with orthopedic
30
Test of **MCL/LCL** injury
1. **MCL** = joint laxity _w/o_ stress test 2. **LCL** = joint laxity _WITH_ varus stress test
31
**_ACL/PCL (anterior cruciate ligament)_** XR How do you get damage to each?
1. **AP/lateral** 2. ACL: valgus + ER to flexed knee + hyperextension 3. PCL: posterior stress to flexed knee
32
Exam for ACL injiry
+ anterior drawer and lachman test
33
Exam for **PCL** injury MAnagement and disposition
**+ posterior drawer** & **sag sign** ## Footnote **knee immbolizer** **ED discharge and F/U with orthopedic**
34
**ankle disolocation** = ?
**articular surface of talus** dissociates from **_tibia**_ + _**fibula_**, _usually associated with a fracture_
35
imaging for **ankle dislocaiton**
**AP/lateral/mortise**
36
**4 main categories** of **dislocations**
1. **Anterior** 2. **lateral** 3. **posterior** 4. **superior**
37
how do you get a **_anterior_ ankle dislocation**
**foot dorsiflexed** and **displaced interiorly.**
38
**Anterior Ankle Dislocation** associated injuries
1. _fracture_ of the **anterior portion of the distal tibia,** 2. _mechanical obstruction_ of **dorsalis pedis artery**
39
**Lateral Ankle Dislocation**
**foot displaced laterally**
40
**_Lateral Ankle Dislocation_** Associated Injuries
1. Medial/ lateral malleolus 2. Distal fibula fractures 3. Deltoid ligament injury
41
**_Posterior Ankle Dislocation_** * how? * associated injuries
**foot plantar flexed** and **displaced** **posteriorly** 1. Fracture of lateral malleolus 2. Disruption of the tibiofibular syndesmosis
42
**_Superior Ankle Dislocation_** * How is it dislocated? * Associated injury
* **Shortened lower leg** with **obvious deformity** * **assx injury** * **Articular damage** * **F**_racture_ to **thoracolumbar** and/or **calcaneus**
43
Management of ankle dislocation
**1. reduce** **2. Posterior short-leg splint w stirrup** **3. dont bear weight**
44
***Ankle Dislocation:*** Disposition
Discuss with **orthopedic specialist** while patient is in the **ED**, almost **always requires surgical management**

PCM 4 Midterm (6 decks)

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